Should doctors go on strike? The ethical dilemmas facing the civil disobedience movement in Myanmar
We recently organized a virtual three-way meeting to discuss what is happening in our homeland, Myanmar. We are all Burmese healthcare professionals who reside in three different places: Japan, Hong Kong and Myanmar. In particular, we wanted to find ways to help our fellow doctors from all over Myanmar. We have been informed that arrest warrants have been issued for the arrest of many of our senior and junior colleagues in the healthcare profession – at least 300 to date, and more are expected in the near future. next days. The health workers who led the Civil disobedience movement in response to the February coup were systematically targeted by the military; some of our colleagues were shot, and others killed, while providing medical assistance to injured protesters and passers-by.
But the working conditions of health workers in Myanmar were very unsatisfactory even before the coup. Our international colleagues are generally shocked to learn that Myanmar doctors are paid as little as US $ 200 per month on average in public hospitals. As the general strike now enters its third month, it is not hard to imagine the strain many of our colleagues and their families are experiencing.
Myanmar’s public health system is now facing a triple crisis: the COVID-19 pandemic; the military coup itself; and the ruthless crackdown on health workers by the military. The second wave of the pandemic has already had devastating consequences for Myanmar’s fragile health system, where health spending is among the lowest in the world. Despite the odds and meager resources, Myanmar doctors have valiantly tried to tackle the COVID-19 outbreak and the country has managed to control the pandemic relatively well. In the ASEAN region, Myanmar is the third country to launch a national immunization program (after Singapore and Indonesia). But all of the hard-earned success was destroyed immediately after the coup and now healthcare workers are in hiding for their safety.
So what should we think of the role that health workers play in the civil disobedience movement? All over the world, strikes by doctors are not uncommon. In Nigeria, for example, doctors are currently on strike to protest against poor working conditions and pay. Earlier this year, public health specialists in Ireland planned to strike against their lower pay scale than hospital consultants. In August last year, South Korean medical students went on strike over controversial national health policy reforms. A month before that, doctors in Sierra Leone had decided to leave their workplaces due to the government’s non-payment of allowances and necessary protection in COVID-19 treatment centers.
Many of these strikes only last a few days – in extreme cases, months – because governments have to take doctors’ demands seriously. They were starting a negotiation process and trying to come to an agreement before the patients felt the effects of the strike. After all, healthcare professionals are widely regarded as an indispensable human resource for any country.
Our Myanmar colleagues not only face the threat of military violence, but they also face a profound ethical dilemma. How can they reconcile their obligations towards their patients and those in need of medical assistance, with their opposition to the coup d’état and their commitment to democracy? They are doing their best to continue providing essential services to the public through the private sector or through makeshift community clinics. Many provide free health services to the poor and even risk their lives dealing with emergencies of protesters injured by brutal military countermeasures.
In our view, the behavior of striking Myanmar healthcare workers is not only selfless in their care of those in need, but also benevolent in their Gandhi-style nonviolent civil disobedience. How could they continue to give their tacit support to an undemocratic and ruthless military regime by working under its auspices? We were therefore surprised to read the articles or comments from the military-backed media in Myanmar claiming that many people have lost their lives due to the involvement of medical professionals in the Civil Disobedience Movement (CDM).
Consider this: Between March 23 and May 21, 2020, six people died from COVID-19; by comparison, 573 people were killed by Myanmar’s military junta between February 1 and April 1, 2021. Many medics lost their lives in the streets during emergency care and rescue missions, and many others were jailed for treating protesters – not to mention those in hiding on arrest warrants. These MDP doctors and medical professionals are not selfish; they are selfless and sacrifice themselves in the name of freedom and justice. We were delighted to learn that the Myanmar Civil Disobedience Movement was nominated for the 2022 Nobel Peace Prize by a group of professors from the University of Oslo.
So, is it ethical for doctors to go on strike? We would say that ethical questions should be directed not to the doctors, but to Myanmar’s military dictator Min Aung Hlaing, who should respond to the doctors’ courage and their plea for justice by restoring power to the elected civilian government. Is it ethical to destroy these precious human resources in such a callous way? The people of Myanmar were traumatized by the February coup and its violent aftermath. Is it ethical for a politician to cause such severe political and social unrest in the midst of a pandemic? These are the pressing ethical questions. And the non-violent, courageous and sacrificial behavior of our Myanmar colleagues ensures that these issues are not forgotten or swept under the rug. When dictatorship becomes a fact, then nonviolent revolution is a right.
Phyu Phyu Thin Zaw is a lecturer at the School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong.
Su Myat Han is a postgraduate researcher in tropical medicine and global health at the University of Nagasaki, Japan, and the Institute of Tropical Medicine, London School of Hygiene and Tropical Medicine, UK.
Thein Min Swe, like Phyu Phyu Thin Zaw and Su Myat Han, is a medical professional. All three are members of Myanmar International Society of Academics and Professionals (ISMSP-MM) – a worldwide association working together for justice in Myanmar.